Uses a professional services setting to study the concept of
factory focus. The rapid growth in the US of ambulatory surgery centres
(surgicentres) provides an evolving illustration of focused factories in
services. Because of the pressures of cost containment, most hospitals
have segmented their surgical market, but have adapted their operations
in a variety of ways. Some keep the inpatient and outpatient survery
integrated in the same facility, while others choose a
plant‐with‐a‐plant or a separate facility. Information concerning costs,
organizational structure, achievement of the advantages and
disadvantages of differentiation from inpatient surgery, service times,
waiting times, customer services offered, and future plans were provided
by 54 hospital‐owned ambulatory surgery centres. Despite a variety of
structural arrangements, the responses were effectively classified by
whether or not they shared operating rooms with inpatient surgery. Those
who shared operating rooms reported significantly less achievement of
the advantages and avoidance of the disadvantages of outpatient surgery.
The shared facilities also reported longer waiting times, less patient
contact and higher average facility charges, despite no significant
differences in length of procedure nor volume of the seven most frequent
procedures. Among the centre directors is the OR group, and 53 per cent
favoured separation of the two surgical settings. All the directors with
separated facilities favoured continued separation. The reasons given to
justify integration emphasized economies of scale and safety, while
those given for separation were customer‐service‐oriented.
To function effectively within the multifaceted environment of the academic medical center, academic physicians need to heighten their understanding of the economics of the health care system, and further develop their leadership and managerial skills. A literature base on organizational development and management education now exists that addresses the unique nature of the professional organization, including academic medical centers. This article describes an administration development curriculum for academic physicians. Competency statements, instructional strategies and references provide the academic physician with guidelines for expanding their professional expertise to include organizational and management skills. The continuing success of the academic medical center as a responsive health care system may depend upon the degree to which academic physicians gain sophistication in self-management and organizational administration.
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